How to detonate your love handles and live longer

We're halfway through National Obesity Awareness Week, but it's tough to be unaware of the mounting problem gripping Brits by the gut. From blaming Britain's booming restaurant culture to campaigning against the sugar companies, the fight against fat rages on.

Here, MH dives in to take an in-depth look at the problems posed by your adipose, and why everyone, from governments to parents to ordinary people, should be doing more about their health.

Do fat people need surgery? A new study from the British Medical Journal recommends the NHS up their quota of gastric band and weight-loss surgeries to a whopping 1,000 a week in order to combat rising obesity. While fat-loss surgery is beneficial to many, we believe diet and exercise can solve a significant portion of this grossly oversized pie chart. But the study does address a concern threatening to drain our health service's resources.

Obesity throughout the country is an epidemic, and we need to act fast before it overwhelms our body, the NHS and the economy. It’s causing a fatal class divide and thousands of deaths. If something isn’t done, our nation could collapse under its own weight.

(Lunch)time bomb

You don’t need a time machine to glimpse this fatter future. A trip to Coatbridge, Lanarkshire will do. According to market researchers CACI, this Scottish town has the UK’s fattest residents. One in five has a BMI above 30 and cabbies limit loads to two passengers. It’s no coincidence that Britain’s fat capital is also one of its most deprived areas. A map of the UK drawn by the National Obesity Observatory (NOO) shows a stark class and geographical divide. The fattest areas include the North East, where unemployment rates are among the highest at 9.6%. Earning power seems directly linked to your girth, with only 21.6% of top-earning households seriously over weight, compared with 29.3 % of households where cash is tight.

If we don’t act, our ‘fatocalypse’ will become reality. The Foresight report predicts that by 2050 we’ll have an economic and health crisis if current trends continue. If you’re one of those making up the far-too-round number, the personal consequences will be dire. The British Dietetic Association warns that risk of fatal disease increases by 1% for every pound you’re overweight. Obesity ups your risk of heart disease by 82%, your risk of type 2 diabetes doubles if your BMI hits 25 and University of Aberdeen research found a 20lb (9kg) weight increase cuts your chances of fatherhood by 10%. Harvard Medical School has even coined a new term for patients suffering from obesity-related diabetes: ‘diabesity.’

Looking at the big picture, the cost to society will be crippling. NHS spending will increase from £104 to £114bn by 2015, but in real terms it will be static, thanks to rising costs and patient numbers. Health charity The King’s Fund and economic think tank The Institute of Fiscal Studies estimate this leaves a £20bn funding gap. “There’s a gap between what we’d like to spend and what we have, and obesity comes into that,” says King’s Fund health economist John Appleby. “NHS funding is flat in real terms and the cash just won’t be there.”

While the NHS budget flatlines, obesity costs are soaring. Over 5.5m over-16s are on obesity registers, a rise of 250,000 in the past year. Research by Diabetes UK shows the impact of this in a 5.5% rise in type 2 diabetes cases in a single year. Treating diabetes costs the NHS an annual £8bn, the cost of prescription weight-loss drugs is up 13% to £47m, and obesity operations 40% to £32m. Perhaps the most shocking figure is that each NHS hospital spends an average of £60,000 annually on ‘supersizing’ beds, wheelchairs and equipment for heavier patients. All this while cancer drugs are being rationed.

The predicted cost to the nation also includes the amount taxpayers will be funding in incapacity benefit for those whose obesity-related health problems mean they can barely walk, let alone travel to an office. “The consequences are so wide-ranging that no country, however wealthy, will be able to afford the fallout – whether it’s pervasive diabetes affecting 30-50% of adults or heart disease, ar thritis, cancers or respiratory problems,” says Professor Philip James, chair of the International Obesity Task Force. He points out that the fat epidemic is already responsible for half of all the increasing costs of the US health sector.

Slim chance

So far, the government’s response has been to ‘nudge’ the public into slimming down, with initiatives like cinema tickets for children who walk to school. The Department of Health says it is ‘concerned’ about the prevalence of obesity and its ‘serious implications’. A spokesman told MH that ministers were ‘working hard’ on new measures but ‘nannying’ people to lose weight is not on the agenda. “The Government’s role is not to lecture people, not to nanny them, not constantly to be legislating or taxing them,” says the DoH spokesman. Many experts argue that more drastic action is needed.

Some German politicians have already suggested fat people should pay higher taxes because of the burden they place on the health system. Or there should at least be a tax on fatty food. “A junk food tax is sound in principle,” says Paul Sacher, specialist dietician at Great Ormond Street Hospital.“ But it will only work if it’s high enough to stop people buying high-fat, sugar and salt foods. Otherwise it just becomes a tax on the poor.” And, he argues, cash raised through a tax on unhealthy foods should be used to subsidise more nutritious foods. Sacher also supports limiting advertising unhealthy foods to children to ‘minimise’ the ‘pester power effect.’

Pay as you gorge

The influential health journalist Ian Marber takes a more radical stance, calling on the Government to bring in National Insurance pay bands which reflect our individual lifestyles. Those who don’t exercise, or have a high body fat, should pay the top band. “Those who don’t drink or smoke and eat healthily should pay the lowest amount,” says Marber. “It’s like any other type of insurance. You pay according to your risk.”

How we stop the next generation from supersizing is one of the most vital issues. Children are feeding their ‘fat future’ before the age of five and parents are often to blame, argues Terry Wilkin, professor of endocrinology and metabolism at Peninsula Medical School in Plymouth. His long-term research found sons of obese fathers are six times more likely to be obese, and he stresses that we need to tackle parents to stop this ‘conveyor belt’. “Obese parents are ‘recycling’ their obesity through inappropriate feeding,” says Wilkin. The demise of family mealtimes has an impact, he argues, because we no longer understand the impact of portion sizes. It’s a theory backed by University of Wales research, which showed children who don’t have set mealtimes don’t learn appropriate eating habits. “It’s vital that we educate children at an early age, but it has to be a whole family approach – the parents buying the food need the knowledge and understanding, too,” says Sacher. Wilkin’s solution is controversial: “We should target obese couples pre-conception.”

Obviously blame doesn’t rest solely at the (partially obscured) feet of overweight individuals. Many stress that the food industry’s role in the global obesity crisis needs to be tackled. No one force-feeds us quarter pounders, but are they playing with our minds? Dr David Kessler, former commissioner of the US Food and Drugs Administration (FDA), warns that food chains – including supermarkets – are manipulating us so that we consume more. His book, the New York Times bestseller The End of Overeating, highlights the use of salt, sugar and fat as the most commonly used ingredients, in terms of dietary manipulation. His investigations revealed that some restaurant chains deliberately increase these ‘killer’ ingredients in starters, so we eat more throughout the meal and are more likely to develop addictive eating behaviour.

A matter of course?

A first step in controlling the food industry could – and many say should – be to ban the use of trans fats. These chemically-altered vegetable oils are public enemy number one, according to Professor Lindsey Davies, president of the UK Faculty of Public Health. They’re in many of processed foods because they’re cheap, bulk ingredients, which prolong shelf lives. But they have no nutritional value, Davies points out, and cause a redistribution of fat tissue into the abdomen, upping your bodyweight, even when you’re controlling calorie intake. Their link to obesity has been confirmed in research by Wake Forest University in the US. “Thousands are dying from them,” says Davies. “And we get hysterical about E. coli, which may kill a handful of people. Trans fats are contaminating food.”

If our weighty issue isn’t tackled now, we could be facing a bleak nutritional future. Wilkin believes there will come a time when there will be draconian measures, just as society came round to a public smoking ban. The Future Foundation goes further, predicting a Christmas Future where sugary foods are banned and chocolate is rationed. It’s not so improbable. In the US, education chiefs in Pennsylvania have drafted regulations limiting classroom birthday parties to one a month.

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